Acute respiratory distress syndrome due toCryptococcus albiduspneumonia: Case report and review of the literature

Although cryptococcal infections due to Cryptococcus neoformans are frequently reported in the immunosuppressed patients, infections related to other Cryptococcus spp. are rarely reported. We are reporting a case of pulmonary infection and ARDS due to C. albidus in a patient receiving immunosuppressive therapy because of Still's disease. The diagnosis was made by tissue biopsy and culture. The patient responded to treatment with amphotericin B lipid complex 400 mg/day. The case is significant in that it reminds of yeasts as a cause of community acquired infection in the immunosuppressed patients.

Prevalence of asthma-associated symptoms in Turkish children

The aim of the first national cross-sectional survey was to determine the prevalence of asthma-like respiratory symptoms and the associated risk factors among children aged 0-17 via interview with the parents by primary care physicians. They were selected through stratified two-stage cluster probability sampling in urban and rural parts of randomly selected 27 of 81 administrative districts in Turkey. Data was collected for 46,813 children (23,512 males and 23,301 females) of whom 66 percent resided in urban areas. The prevalence of physician-diagnosed asthma was 0.7 percent. The lifetime and current (last 12 months) prevalences were 14.7 percent and 2.8 percent for asthma, and 15.1 percent and 3.4 percent for wheezing respectively. The presence of personal atopy and history of family atopy were the most significant risk factors for current prevalences of wheezing, and asthma [adjusted Odds ratios (OR) and 95% confidence intervals (CI) were 6.2 (CI=4.0-9.5) and 1.8 (CI=1.3-2.4) for wheezing, and 8.5 (CI=5.6-12.9) and 1.9 (CI=1.4-2.5) for asthma, respectively]. Though there were no significant differences among those residing in urban versus rural areas regarding the current prevalences of asthma and wheezing, those living in coastal areas had considerably higher current prevalences than those inland (OR=2.6, CI=1.9-3.5 for wheezing, and OR=2.3, CI=1.7-3.1 for asthma). Residence in northern Turkey appeared to be a significant risk factor for wheezing (OR=1.9, CI=1.4-2.5), and children resident in southern Turkey exhibited the highest risk for occurrence of asthma (OR=1.5, CI=1.1-2.0) compared with eastern Turkey. In conclusion, the respiratory symptoms associated with asthma were an important cause of morbidity in childhood in Turkey. The discrepancy between prevalence of physician-diagnosed asthma and lifetime and/or current asthma prevalence figures may reflect the reluctancy of both physicians and parents to diagnose this condition. Besides strongest associations with personal atopy and atopic heredity, there were significant differences in prevalence rates between children residing in different regions, supporting the role of environmental factors.

Prevalence of asthma and allergic diseases in primary school children in Ankara, Turkey: two cross-sectional studies, five years apart

The prevalence of allergic diseases is reported to have increased worldwide. Two questionnaire surveys, five years apart, were conducted to evaluate the trend of prevalence rates and possible risk factors among primary school children in Ankara, Turkey. A previous survey in 1992 revealed the lifetime prevalences of asthma, wheezing, allergic rhinitis and atopic dermatitis were 17.4%, 23.3%, 28% and 6.1%, and the prevalences for the last 12 months were 8.3%, 11.9%, 15.4% and 4%, respectively. The survey was repeated with the same questionnaire in the same age group (6-13 years) of the same school in May 1997. The parents of 358 boys and 380 girls completed the questionnaire. The lifetime and last 12 months' prevalences of asthma, wheezing, rhinitis and atopic dermatitis were 16.8%, 22.5%, 18.7%, 6.5%, and 9.8%, 13.3%, 14.1%, 4.3%, respectively. There was a significant change only for the lifetime prevalence of rhinitis (p < 0.001). The rate of indoor smoking had declined from 73.9% to 64%, and pet ownership had risen from 7.9% to 22.9% (p < 0.001 for both). Atopic family history was the most prominent risk factor for all types of allergic disorders. Male gender was a significant risk factor for current asthma and wheezing [odds ratio (OR) = 1.80 and 1.59; 95% confidence intervals (CI) = 1.09-2.98 and 1.01-2.48, respectively], and passive smoking affected the occurrence of allergic rhinitis (OR = 1.84; CI = 1.13-3.00). The prevalence rates of allergic diseases among primary school children in Ankara stabilized during a 5-year period for all diseases other than allergic rhinitis. However, there are changing behavior patterns, i.e. indoor smoking and keeping pet animals, which that may have affected these rates.

Calcium within a bronchogenic cyst with a fluid level

A 38-year-old man presented with a bronchogenic cyst which showed a high calcium content. The calcium precipitate layered in the dependent part of the cyst to form a fluid level. The CT and MRI findings of this rare case are discussed.

The prevalence of allergic diseases in primary school children in Edirne, Turkey

BACKGROUND

Allergic diseases present a major health burden for children as shown by the rising morbidity and increased mortality from asthma. Information on the prevalences of allergic disorders and contributing factors as well will help to establish feasible measures to change this trend, and more efficient assignment of the limited health resources.

OBJECTIVE

To assess the prevalences of asthma and other allergic diseases and the contribution of various risk factors in primary school children in Edirne, Turkey.

METHODS

Children aged 7 to 12 in primary schools in the municipality and 24 villages of Edirne were surveyed via a questionnaire completed by the parents. The cumulative (lifetime) and current (last 12 months) prevalences of allergic diseases and the presence of passive smoking, atopic family history, animal contact and breast-feeding in infancy were determined.

RESULTS

A total of 5412 children (70.1% from the metropolitan and 29.9% from the rural area) were enrolled. The cumulative and current prevalences of all allergic diseases were 24.6% and 9.9% respectively. The cumulative (lifetime) prevalences of bronchial asthma, wheezing, allergic rhinitis and atopic dermatitis were 16.4%, 18.9%, 12.3% and 2.2%, and the current (last 12 months) prevalences were 5.6%, 5.8%, 4.5% and 0.9% respectively. Three-fourths of the children were exposed to tobacco smoke at home. Atopic heredity appeared the most prominent risk factor for any allergic disorder. Neither age, breast-feeding nor place of habitation affected the occurrence of allergic disorders. Animal contact was a significant risk factor for asthma and wheezing (adjusted odd ratios (OR) and 95% confidence intervals (CI) for current prevalences are 1.38 (CI = 1.04-1.83) and 1.35 (CI = 1.02-1.78) respectively), exposure to indoor tobacco smoke for wheezing (OR = 1.52, CI = 1.10-2.09), and male gender for asthma (OR = 1.50, CI = 1.16-1.93). Current prevalences for all allergic diseases were significantly lower than those previously reported in Ankara, Turkey.

CONCLUSIONS

Allergic diseases are a major health burden for primary school children in Edirne, Turkey. Although atopic heredity appears to be the foremost important risk factor, reduction of exposure to indoor tobacco smoke and animal contact, especially for those with atopic family history, are important preventive measures. The impact of environmental exposures on distinguishing prevalences of allergic diseases in Ankara and Edirne should be further investigated.

An epidemiological study in an Anatolian village in Turkey environmentally exposed to tremolite asbestos

After several cases of malignant pleural mesothelioma (MPM) were detected in the village of Kureyşler in the Kütahya district of western Turkey, an epidemiological study was conducted. A questionnaire was completed by 124 villagers who were older than 20 years and standard posteroanterior chest X-rays were taken. The films were evaluated by three chest physicians. Samples of the white stucco that had been used by almost all villagers for indoor painting for many years were mineralogically examined. Chest X-rays showed that 23 (18%) had pleural plaques and calcifications compatible with asbestos exposure. Male sex and old age were associated with occurrence of pleural plaques. An analysis of white stucco samples revealed tremolite asbestos. In conclusion, tremolite fibers might be the cause of the high incidence of pleural plaques and MPM cases in the village of Kureyşler.

Survey of the allergic status of patients with bronchial asthma in Turkey: a multicenter study

Patients diagnosed with bronchial asthma (BA) were prospectively enrolled to assess their allergen spectra and atopic status. The patients came from five major cities (Ankara, Izmir, Samsun, Elaziğ, and Adana) in different regions of Turkey. Atopic status, total IgE levels, and allergen spectra were determined in 1149 patients and 210 controls who were spouses of the patients sharing the same environment but not consanguinity with the patients. Total IgE levels were significantly higher in the asthmatic patients. For both groups, total IgE levels were higher in both atopic and male subjects. Atopy rates were 42% in asthmatics and 26.1% in controls, declining notably by age in both groups. The most common allergen in both groups was house-dust mite (HDM), which was more frequently detected in coastal regions (Samsun, Izmir, and Adana). Allergen spectra of the patients included HDM, pollens, cockroach, pet animals, and molds in decreasing order of frequency. Phleum pratense and Artemisia vulgaris were the most common pollens in all regions, whereas Olea europaea was the most common in Izmir. Pollen sensitivity was least frequent in Elaziğ. For all of the regions, pet sensitivity was less common than, and mold sensitivity was comparable to, that of Western countries. In conclusion, BA patients in Turkey displayed significant differences in their allergen spectra and total IgE levels from control subjects and BA patients in Western countries.

Prevalence of childhood asthma and allergic diseases in Ankara, Turkey

The first epidemiologic survey of the prevalence of childhood asthma and other allergic disease in Ankara, Turkey, was done in May 1992. A questionnaire on factors influencing the atopic status and allergic symptoms was distributed to parents of 1226 children aged 6-12 years. In this questionnaire, parents were asked to give information about physician-diagnosed asthma and atopic dermatitis (AD), and self-reported wheezing and rhinoconjunctivitis (perennial or seasonal). The overall response rate was 85% and included 502 boys (48.5%) and 534 girls (51.5%). The lifetime prevalences of asthma, wheezing, rhinoconjunctivitis, and AD were 17.4%, 23.3%, 28%, and 6.1%, respectively, and the reported prevalences for the last 12 months were 8.3%, 11.9%, 15.4%, and 4%, respectively. Asthma and other allergic disease had been recognized in 23.2% of the children during the last year; in half of these, more than one disease was present. Eight percent of the families kept pet animals; 95.4% of children had been breast-fed, of whom 61% for more than 6 months; and at least one person smoked at home in the case of 73.9% of children. Some health insurance was available to 72.8% of the families. Cumulative prevalences of wheezing, rhinoconjunctivitis, and AD were significantly associated with the presence of pets, passive smoking at home, and absence of health insurance. The prevalence of asthma was not affected by any of these factors except atopic family history. In conclusion, asthma and other allergic diseases constitute a major health problem for schoolchildren in Ankara.

Malignant pleural mesothelioma caused by environmental exposure to asbestos or erionite in rural Turkey: CT findings in 84 patients

OBJECTIVE

Malignant pleural mesothelioma in rural Turkey frequently results from environmental exposure to tremolite asbestos or fibrous zeolite (erionite). The aim of this study was to determine the CT features of malignant pleural mesothelioma in patients exposed to asbestos or erionite.

MATERIALS AND METHODS

The CT scans of 84 patients with proved malignant pleural mesothelioma were retrospectively evaluated. Twenty patients (24%) had been exposed to erionite and 64 patients (76%) had been exposed to asbestos. The CT scans were interpreted by seven observers who did not know the clinical or pathologic findings.

RESULTS

CT scans showed either unilateral pleural thickening or pleural nodules/masses in all patients. Pleural nodules were present in 25 patients (30%) and pleural masses in 44 patients (52%). Pleural effusion was found in 61 patients (73%), mediastinal pleural involvement in 78 (93%), pleural calcifications in 52 (62%), involvement of the interlobar fissures in 64 (76%), and volume contraction in 61 (73%). Reduced size of the hemithorax was significantly correlated with chest wall involvement. On the basis of CT findings, the preassigned staging was changed in 21 patients (25%), including 44% of the patients with disease that had been classified as stage I. CT findings were not significantly different between the patients exposed to erionite and those exposed to asbestos.

CONCLUSION

The most common CT findings in cases of malignant pleural mesothelioma were unilateral pleural thickening or pleural nodules/masses with or without effusion. CT provided valuable information on the extent of the disease, which was important for staging. Although the CT features are not pathognomonic, they provide valuable clues to the diagnosis in patients who have been exposed to mineral fibers.

Malignant pleural mesothelioma due to environmental mineral fiber exposure in Turkey. Analysis of 135 cases

We reviewed data from 135 patients with environment-associated malignant pleural mesothelioma (MPM) from the Central Anatolian region of Turkey. The most significant factors suggesting the diagnosis of MPM were the village where the patient resided and the typical presenting symptoms and signs of unilateral exudative pleural effusion associated with nonpleuritic chest pain. Computed tomography and ultrasonography were very useful for evaluating the extension of the tumor in the thoracic and abdominal cavities and chest wall. The tissue diagnosis was established by either thoracoscopy (39 percent) or pleural biopsy (39 percent) in the majority of the cases. The median survival after diagnosis was 13.52 months for erionite-associated MPM and 21.56 months for asbestos-associated MPM. The actuarial survival curves for the fibrous minerals were significantly different for survival computed both from onset of the symptoms and after diagnosis. Medical or surgical treatment or both did not change the outcome of the disease.

Life threatening chylous pleural and pericardial effusion in a patient with Behçet's syndrome

Chylothorax and chylopericardium secondary to thrombosis of the superior vena cava and the innominate and subclavian veins were diagnosed in a patient with Behçet's syndrome. Immunosuppressive treatment, diet, and underwater seal drainage led to a diminished volume of pleural fluid and pericardial fluid and to a diminished concentration of triglyceride in them; pleurodesis with tetracycline was then performed.

Hypertrophic pulmonary osteoarthropathy in a patient with pulmonary alveolar microlithiasis

Hypertrophic pulmonary osteoarthropathy occurred in a patient with proved pulmonary alveolar microlithiasis, an association not previously reported.